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Defining Outcomes for Infants <1,000g; The Importance of Requiring Re-Intubation Beyond the First Days of Life

Friday, October 19, 2012
Room R02-R05 (Morial Convention Center)
Kevin C. Dysart, M.D.1, Sharon Kirkby2, Linda Genen2 and Jay Greenspan, MD, MBA3, (1)Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, (2)Women's and Children's Health, Alere, Atlanta, GA, (3)Pediatrics, A.I. duPont Hospital for Children, Wilmington, DE

Background: Preterm birth is a significant problem in newborn medicine, as is the lung injury suffered by infants born <1,000 g. The last decade has seen many changes in care including the use of non-invasive ventilation strategies and the avoidance of mechanical ventilation(MV). Despite these attempts negative outcomes occur at high rates and there continues to be limited objective clinical data to define at risk infants beyond the first week of life.

Purpose: To assess the impact of requiring reintubation in infants < 1000g on NICU course and outcomes.

Methods: Retrospective analysis of all surviving infants <1000 grams from a large neonatal database from 6/2006-9/2011. Infants included were all those initially ventilated and then either extubated successfully and never reintubated, extubated and reintubated within 14 days and those reintubated later. Outcomes measured were chronic lung disease (CLD), necrotizing enterocolitis (NEC), severe intraventricular hemorrhage (IVH), severe retinopathy of prematurity (ROP), later sepsis, need for high frequency ventilation(HFV), and length of stay (LOS). Multivariate regression analysis controlled for gestational age (GA), birth weight (BW), and gender.

Results: 3027 infants were born during the study period and 1155 met inclusion criteria. After controlling for GA, BW and gender reintubated infants were significantly more likely to develop CLD(OR-5.11), IVH(OR-2.9), ROP(OR-4.3), sepsis(OR-2.9) and NEC(OR-3.1), receive systemic steroids(OR-6.8) and have a significantly longer LOS.

Comparing only those reintubated, infants intubated after day 14 required more HFV days and were ventilated more days initially.

Conclusion: Initial need for intubation and MV did not portend a negative outcome; however, the need for reintubation and MV a 2nd time significantly altered the clinical course for infants < 1000g. This clinical event redefines illness severity after the 1st week of life. Early identification of infants likely to experience negative short and long-term outcomes is crucial in developing future therapies for this at risk population.